Anish R Mitra1,2,3, Donald E G Griesdale4,5, Gregory Haljan6,4, Ashley O'Donoghue7, Jennifer P Stevens7,8. 1. Division of Critical Care Medicine, Department of Medicine, Surrey Memorial Hospital, Surrey, BC, Canada. anish.mitra@fraserhealth.ca. 2. Department of Medicine and Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada. anish.mitra@fraserhealth.ca. 3. Intensive Care Unit - Surrey Memorial Hospital, 13750, 96th Ave, Surrey, BC, V3V 1Z2, Canada. anish.mitra@fraserhealth.ca. 4. Department of Medicine and Division of Critical Care Medicine, University of British Columbia, Vancouver, BC, Canada. 5. Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada. 6. Division of Critical Care Medicine, Department of Medicine, Surrey Memorial Hospital, Surrey, BC, Canada. 7. Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA, USA. 8. Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Abstract
PURPOSE: High acuity units (HAU) are hospital units that provide patients with more acute care and closer monitoring than a general hospital ward but are not as resource intensive as an intensive care unit (ICU). Nevertheless, the impact of opening a HAU on ICU patient outcomes remains poorly defined. We investigated how the creation of a HAU impacted patient outcomes in the ICU. METHODS: This historical cohort study compared ICU patient in-hospital mortality, ICU length of stay (LOS), and hospital LOS before and after the creation of a HAU in a tertiary-care hospital with a medical/surgical ICU between 1 January 2013 and 31 December 2017. RESULTS: Data from 4,380 patients (984 in the pre-HAU group and 3,396 in the post-HAU group) were analyzed. In this cohort of ICU patients, 360 (37%) died in the pre-HAU group before the creation of a HAU, and 1,074 (32%) died in the post-HAU group after the creation of a HAU. The creation of a HAU was associated with lower relative risk of in-hospital mortality (adjusted risk ratio, 0.80; 95% confidence interval [CI], 0.72 to 0.89; P < 0.001). The creation of a HAU was also associated with reduced ICU and hospital LOS with a 12% increase in the rate of ICU discharge (adjusted sub-distribution hazard ratio [SHR], 1.12; 95% CI, 1.02 to 1.23; P = 0.02) and a 26% increase in the rate of hospital discharge (adjusted SHR, 1.26; 95% CI, 1.14 to 1.39; P < 0.001), when accounting for the competing risk of death. CONCLUSIONS: These data support the hypothesis that the creation of a HAU may be associated with reduced in-hospital mortality, ICU LOS, and hospital LOS for ICU patients.
PURPOSE: High acuity units (HAU) are hospital units that provide patients with more acute care and closer monitoring than a general hospital ward but are not as resource intensive as an intensive care unit (ICU). Nevertheless, the impact of opening a HAU on ICU patient outcomes remains poorly defined. We investigated how the creation of a HAU impacted patient outcomes in the ICU. METHODS: This historical cohort study compared ICU patient in-hospital mortality, ICU length of stay (LOS), and hospital LOS before and after the creation of a HAU in a tertiary-care hospital with a medical/surgical ICU between 1 January 2013 and 31 December 2017. RESULTS: Data from 4,380 patients (984 in the pre-HAU group and 3,396 in the post-HAU group) were analyzed. In this cohort of ICU patients, 360 (37%) died in the pre-HAU group before the creation of a HAU, and 1,074 (32%) died in the post-HAU group after the creation of a HAU. The creation of a HAU was associated with lower relative risk of in-hospital mortality (adjusted risk ratio, 0.80; 95% confidence interval [CI], 0.72 to 0.89; P < 0.001). The creation of a HAU was also associated with reduced ICU and hospital LOS with a 12% increase in the rate of ICU discharge (adjusted sub-distribution hazard ratio [SHR], 1.12; 95% CI, 1.02 to 1.23; P = 0.02) and a 26% increase in the rate of hospital discharge (adjusted SHR, 1.26; 95% CI, 1.14 to 1.39; P < 0.001), when accounting for the competing risk of death. CONCLUSIONS: These data support the hypothesis that the creation of a HAU may be associated with reduced in-hospital mortality, ICU LOS, and hospital LOS for ICU patients.
Authors: Lucienne T Q Cardoso; Cintia M C Grion; Tiemi Matsuo; Elza H T Anami; Ivanil A M Kauss; Ludmila Seko; Ana M Bonametti Journal: Crit Care Date: 2011-01-18 Impact factor: 9.097
Authors: Barbara C J Solberg; Carmen D Dirksen; Fred H M Nieman; Godefridus van Merode; Graham Ramsay; Paul Roekaerts; Martijn Poeze Journal: BMC Anesthesiol Date: 2014-09-06 Impact factor: 2.217